Effective Control of an Outbreak of Sepsis After Prostate Biopsy Using Antibiogram-Guided Antimicrobial Prophylaxis

Abstract

Background: The emergence of strains of Escherichia coli (E. coli) that are resistant to fluoroquinolones (FQ) has resulted in an increase in infectious complications associated with transrectal ultrasound-guided prostate biopsy (TRUSPB). Two strategies have been proposed to deal with the increase: broadening the antimicrobial coverage and individualizing prophylaxis using transrectal swab cultures. This article describes an alternative strategy, one that adjusts TRUSPB prophylaxis, using the local antibiogram as a guide. Methods: In 2012, screening software for electronic medical records facilitated the identification of seven patients who presented with sepsis within 10 days of a TRUSPB at the Bruce W. Carter Department of Veterans Affairs Medical Center in Miami, Florida. At the time, TRUSPB antimicrobial prophylaxis consisted of oral ciprofloxacin and an intramuscular dose of gentamicin. The outbreak of TRUSPB-associated sepsis between January and June 2012 prompted a reassessment of this regimen, which, based upon the local antibiogram, was then changed to oral cefuroxime. Results: In 2011, one case of TRUSPB-associated sepsis was identified among 282 biopsies performed (0.4%). Between January and June 2012, seven cases occurred among 129 biopsies (5.4%). The facility's 2011 antibiogram revealed that 45% of E. coli strains were resistant to FQs and 10% were resistant to cephalosporins. A new regimen consisting of cefuroxime, an oral, second-generation cephalosporin, given twice daily, starting the evening before a TRUSPB, was implemented. One case of TRUSPB-associated sepsis occurred in the next 101 biopsies (1%). Conclusions: It is important for institutions to be aware of local microbiological trends and antimicrobial resistance. Local data from the institutional antibiogram can be a useful tool for making timely adjustments to antimicrobial prophylaxis for TRUSPB.